Legal Issues and Sample Release Form

Legal Issues concerning screenings

Before any screening is performed, a medical release form needs to be signed by the participant. This is important. The main purpose of the medical release form is to release all parties from liability. It stresses that this is only a screening and not a diagnosis. For a diagnosis, you need to go to your doctor.

For example, suppose a person has a blood pressure screening and they are told that they have a slightly elevated reading due to an equipment error. They see their doctor, then later they end up in the hospital due to a stroke, you are not held liable.

Likewise, in the case of children, if any screenings are performed, their parents need to give permission by signing a release form.

Normally the agency that performs the screening brings the medical release form.

Sample Release Form

Please incorporate these elements into any release form you might develop for your fair.

If you have community partners you will also want to check with them. Laws concerning release of medical information and individual privacy have changed recently and continue to be refined in their interpretation.

Release Form
I request the cholesterol/glucose (for example) screening be performed on me by __________ and release them, their affiliates, officers, directors, volunteers and employees from any and all liabilities, injuries or losses including any matter or item committed or omitted which may arise during these screening or examination procedures.

I understand that:

1. These data are considered preliminary and results are in no way conclusive.
2. The results will be told to me at the time of the screening.
3. The responsibility for initiating any follow-up examinations for abnormalities identified lies with me.
4. The glucose screen is not designed for screening pregnant women or known diabetics.
5. No outside individuals or organizations will have access to the results of my screening without my permission.

Signature:_____________________ Date:___________